Appropriate Codes to use for Authorization Closures or Denials
Denial/Closure Reasons for LT or SW Authorizations:
- 1
- = Death of client
- 2
- = Client’s request
- 3
- = Change in level of care – new provider
- 4
- = Change in providers
- 6
- = Change in the DHS case number for authorization
- 7
- = Provider no longer eligible
- 10
- = Financial eligibility not met
- 21
- = Transfer of resources
- 22
- = Moved out of state
- 23
- = Unable to locate
- 44
- = Failed or refused to cooperate in determining eligibility
- 45
- = Failed or refused to provide necessary verification within the time allowance
- 49
- = Entered nursing facility
- 69
- = Other – no notice will be generated
- 99
- = State Office use only
Denial/Closure Reasons SW Authorizations Only:
The list shown here lists the codes that are improper to use. These codes should NOT be utilized by AFS LTC staff.
- 11
- = You Are Not In A Targeted Group for the Advantage Waiver
- 14
- = The Cost of Service Exceeds the Allowable Capitalization
- 15
- = There is No Open Advantage Waiver Slot
- 16
- = Your Needs Cannot Be Met Through Advantage Waiver Services
- 17
- = Harm to Self or Others
- 18
- = A Household Member or Frequent Guest Threaten Harm to Others
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